Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears.
Occipital neuralgia can be the result of pinched nerves or muscle tightness in the neck. It can also be caused by a head or neck injury. Occipital neuralgia can either be primary or secondary. A secondary condition is associated with an underlying disease.
Although any of the following may be causes of occipital neuralgia, many cases can be attributed to chronic neck tension or unknown origins.
Symptoms of occipital neuralgia include continuous aching, burning and throbbing, with intermittent shocking or shooting pain that generally starts at the base of the head and goes to the scalp on one or both sides of the head. Patients often have pain behind the eye of the affected side of the head. Additionally, a movement as light as brushing hair may trigger pain. The pain is often described as migraine-like and some patients may also experience symptoms common to migraines and cluster headaches.
Occipital neuralgia can be very difficult to diagnose because of its similarities with migraines and other headache disorders. Therefore, it is important to seek medical care when you begin feeling unusual, sharp pain in the neck or scalp and the pain is not accompanied by nausea or light sensitivity. Begin by addressing the problem with your primary care physician. They may refer you to a specialist.
Diagnosis of occipital neuralgia is tricky, because there is not one concrete test that will reveal a positive or negative diagnosis. Typically, a physical examination and neurological exam will be done to look for abnormalities. If the physical and neurological exams are inconclusive, a doctor may order further imaging to rule out any other possible causes of the pain. A magnetic resonance imaging (MRI) test may be ordered, which can show three-dimensional images of certain body structures and can reveal any impingement. A computed tomography scan (CT or CAT scan) will show the shape and size of body structures. Some doctors may use occipital nerve blocks to confirm their diagnosis.
Treatment of occipital neuralgia aims to alleviate the pain; however, it is not a cure. Interventions can be surgical or non-surgical.
Patients are encouraged to regularly follow up with their primary care providers and specialists to maintain their treatment. Surgeons like patients to return to the clinic every few months in the year following the surgery. In these visits, they may adjust the stimulation settings and assess the patient’s recovery from surgery. Following up with a doctor ensures that the patient is getting correct and effective care. Patients who undergo occipital nerve stimulation will follow up with a device representative who will adjust their device settings and parameters as needed, alongside their doctors.
Patient Pages are authored by neurosurgical professionals, with the goal of providing useful information to the public.
Julie G Pilitsis, MD, PhD, FAANS
Chair, Neuroscience & Experimental Therapeutics
Professor, Neurosurgery and Neuroscience & Experimental Therapeutics
Albany Medical College
Dr. Pilitsis specializes in neuromodulation with research interests in treatments for movement disorders and chronic pain.
Olga Khazen, BS
Neuroscience & Experimental Therapeutics
Albany Medical College
The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information provided is an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.
What does a headache near the back of the neck mean?
Cervicogenic Headache It's a pain in the neck that you feel in your head. People often develop cervicogenic headaches after an injury that causes whiplash or as a result of a pinched nerve in the neck. Arthritis, neck sprains or a neck fracture can also lead to cervicogenic headaches.
How do you get rid of a headache in the back of your head and neck?
Treatment generally includes warm compresses and gentle massage. Anti-inflammatory medications and muscle relaxers may help, too. If you have these headaches often, your doctor may prescribe antidepressants or antiepileptic drugs to lessen the attacks.
When should I worry about headaches and neck pain?
Headaches that get steadily worse. Changes in personality or mental function. Headaches that are accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures.
When should I worry about headaches in the back of my head?
Your headache comes on suddenly and is explosive or violent. Your headache is "the worst ever," even if you regularly get headaches. You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. Your headache gets worse over 24 hours.